BACKGROUND: The incidence of and causes for permanent pacemaker implantation (PPM) after surgical arrhythmia procedures remain poorly understood because of the varied lesion patterns and energy sources reported in small series. This study characterized the incidence, indications, and risk factors for PPM after the Cox-maze IV (CMIV) procedure when performed as either a lone or a concomitant procedure. METHODS: A retrospective analysis of 340 patients undergoing a CMIV as either a lone (n = 112) or a concomitant (n = 228) procedure was conducted. The incidence, indication, and variables associated with PPM implantation within 1 year of the operation were assessed. Follow-up was conducted at 30 days and 1 year and was 90% complete. RESULTS: The incidence of PPM after a lone CMIV procedure was 5%. Patients with concomitant cardiac operations had a nonsignificant increase in PPM insertion at 30 days (11% vs 5%, p = 0.14) and 1 year (15% vs 6%, p = 0.06) when compared with lone CMIV patients. Of patients who required pacemakers, sinus node dysfunction was present in 79% (35/44) of patients in the entire series and in 88% (8/9) after lone CMIV. After PPM, 84% (37/44) of patients remained paced at last follow-up. Multivariate analysis identified age (odds ratio = 1.10 [1.06-1.14], p < 0.001) as the only variable associated with higher risk of a PPM after any CMIV procedure. CONCLUSIONS: The risk of PPM implantation after a lone CMIV is 5% and increases with age. The need for a PPM after a CMIV is largely due to SA node dysfunction, which appears unlikely to recover. These data should help physicians counsel patients regarding the perioperative risks associated with the CMIV.
BACKGROUND: The incidence of and causes for permanent pacemaker implantation (PPM) after surgical arrhythmia procedures remain poorly understood because of the varied lesion patterns and energy sources reported in small series. This study characterized the incidence, indications, and risk factors for PPM after the Cox-maze IV (CMIV) procedure when performed as either a lone or a concomitant procedure. METHODS: A retrospective analysis of 340 patients undergoing a CMIV as either a lone (n = 112) or a concomitant (n = 228) procedure was conducted. The incidence, indication, and variables associated with PPM implantation within 1 year of the operation were assessed. Follow-up was conducted at 30 days and 1 year and was 90% complete. RESULTS: The incidence of PPM after a lone CMIV procedure was 5%. Patients with concomitant cardiac operations had a nonsignificant increase in PPM insertion at 30 days (11% vs 5%, p = 0.14) and 1 year (15% vs 6%, p = 0.06) when compared with lone CMIV patients. Of patients who required pacemakers, sinus node dysfunction was present in 79% (35/44) of patients in the entire series and in 88% (8/9) after lone CMIV. After PPM, 84% (37/44) of patients remained paced at last follow-up. Multivariate analysis identified age (odds ratio = 1.10 [1.06-1.14], p < 0.001) as the only variable associated with higher risk of a PPM after any CMIV procedure. CONCLUSIONS: The risk of PPM implantation after a lone CMIV is 5% and increases with age. The need for a PPM after a CMIV is largely due to SA node dysfunction, which appears unlikely to recover. These data should help physicians counsel patients regarding the perioperative risks associated with the CMIV.
Authors: Véronique L Roger; Alan S Go; Donald M Lloyd-Jones; Emelia J Benjamin; Jarett D Berry; William B Borden; Dawn M Bravata; Shifan Dai; Earl S Ford; Caroline S Fox; Heather J Fullerton; Cathleen Gillespie; Susan M Hailpern; John A Heit; Virginia J Howard; Brett M Kissela; Steven J Kittner; Daniel T Lackland; Judith H Lichtman; Lynda D Lisabeth; Diane M Makuc; Gregory M Marcus; Ariane Marelli; David B Matchar; Claudia S Moy; Dariush Mozaffarian; Michael E Mussolino; Graham Nichol; Nina P Paynter; Elsayed Z Soliman; Paul D Sorlie; Nona Sotoodehnia; Tanya N Turan; Salim S Virani; Nathan D Wong; Daniel Woo; Melanie B Turner Journal: Circulation Date: 2011-12-15 Impact factor: 29.690
Authors: Lindsey L Saint; Ralph J Damiano; Phillip S Cuculich; Tracey J Guthrie; Marc R Moon; Nabil A Munfakh; Hersh S Maniar Journal: J Thorac Cardiovasc Surg Date: 2013-08-30 Impact factor: 5.209
Authors: Mitchell Pet; Jason O Robertson; Marci Bailey; Tracey J Guthrie; Marc R Moon; Jennifer S Lawton; Andrew Rinne; Ralph J Damiano; Hersh S Maniar Journal: J Thorac Cardiovasc Surg Date: 2012-07-19 Impact factor: 5.209
Authors: Hugh Calkins; Karl Heinz Kuck; Riccardo Cappato; Josep Brugada; A John Camm; Shih-Ann Chen; Harry J G Crijns; Ralph J Damiano; D Wyn Davies; John DiMarco; James Edgerton; Kenneth Ellenbogen; Michael D Ezekowitz; David E Haines; Michel Haissaguerre; Gerhard Hindricks; Yoshito Iesaka; Warren Jackman; José Jalife; Pierre Jais; Jonathan Kalman; David Keane; Young-Hoon Kim; Paulus Kirchhof; George Klein; Hans Kottkamp; Koichiro Kumagai; Bruce D Lindsay; Moussa Mansour; Francis E Marchlinski; Patrick M McCarthy; J Lluis Mont; Fred Morady; Koonlawee Nademanee; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Douglas L Packer; Carlo Pappone; Eric Prystowsky; Antonio Raviele; Vivek Reddy; Jeremy N Ruskin; Richard J Shemin; Hsuan-Ming Tsao; David Wilber Journal: Heart Rhythm Date: 2012-03-01 Impact factor: 6.343
Authors: Thomas Schroeter; Axel Linke; Martin Haensig; Denis R Merk; Michael A Borger; Friedrich W Mohr; Gerhard Schuler Journal: Europace Date: 2012-06-24 Impact factor: 5.214
Authors: John M Stulak; Joseph A Dearani; Thoralf M Sundt; Richard C Daly; Hartzell V Schaff Journal: Ann Thorac Surg Date: 2011-06 Impact factor: 4.330
Authors: Barbara E Bussink; Anders G Holst; Lasse Jespersen; Jaap W Deckers; Gorm B Jensen; Eva Prescott Journal: Eur Heart J Date: 2012-09-04 Impact factor: 29.983
Authors: Joseph J DeRose; Donna M Mancini; Helena L Chang; Michael Argenziano; François Dagenais; Gorav Ailawadi; Louis P Perrault; Michael K Parides; Wendy C Taddei-Peters; Michael J Mack; Donald D Glower; Babatunde A Yerokun; Pavan Atluri; John C Mullen; John D Puskas; Karen O'Sullivan; Nancy M Sledz; Hugo Tremblay; Ellen Moquete; Bart S Ferket; Alan J Moskowitz; Alexander Iribarne; Annetine C Gelijns; Patrick T O'Gara; Eugene H Blackstone; A Marc Gillinov Journal: J Am Coll Cardiol Date: 2019-05-21 Impact factor: 24.094
Authors: Matthew C Henn; Christopher P Lawrance; Laurie A Sinn; Jacob R Miller; Richard B Schuessler; Marc R Moon; Spencer J Melby; Hersh S Maniar; Ralph J Damiano Journal: Ann Thorac Surg Date: 2015-07-22 Impact factor: 4.330
Authors: Camilla Skals Engelsgaard; Kenneth Bruun Pedersen; Lars Peter Riber; Peter Appel Pallesen; Axel Brandes Journal: Int J Cardiol Heart Vasc Date: 2018-04-13